Utilization Review Research Articles

Potential drug-drug interactions with phentermine among long-term phentermine consumers: A retrospective analysis.

Phentermine is an internationally recognised amphetamine derivative with significant appetite-suppressing properties. The drug is indicated for the short-term management of obesity, as the long-term (LT) use of phentermine may potentially be associated with severe cardiovascular side-effects, abuse and dependence. The LT use hereinafter describes periods exceeding 12consecutive weeks. This use may also be associated with potential drug-drug interactions (PDDIs), which may result in adverse drug reactions (ADRs). The literature reports that phentermine is often prescribed LT and for several other off-label indications, increasing the risk for individuals to experience adverse drug events (ADEs) and drug-drug interactions (DDIs). There are, to our knowledge, no South African (SA) studies investigating the prevalence of co-prescribing LT phentermine with drugs that may potentially cause DDIs. To determine the prevalence of mild, moderate and severe DDIs with phentermine use when the duration of therapy in private healthcare exceeded 12consecutive weeks. A cross-sectional drug utilisation review (DUR) was done by using data obtained from a SA pharmacy benefit management (PBM) company's database. Retrospective data of medicine claims for phentermine, from 1 January 2015 to 31 December 2019, were extracted for analysis. The number of days phentermine was supplied was used to identify the study population, in other words, those patients who received the drug LT. A drug interaction checker (Drugs.com) was used to identify potential mild, moderate and severe DDIs when using phentermine and co-prescribed drugs concurrently. A total of 889 patients received phentermine LT. The top 20 drugs identified as being frequently co-prescribed in this study population demonstrated no mild PDDI, 15 (75%) moderate PDDIs and 5 (25%) severe PDDIs. The most common co-prescribed drug in the moderate group was dextromethorphan (n=282, 31.72%) and the least co-prescribed was formoterol (n=52, 5.85%). Among the drug group 'severe PDDIs', tramadol (n=416, 46.79%) was most frequently prescribed, whereas phenylpropanolamine (n=69, 7.76%) was the least prescribed to patients in this group. There are patients who receive LT phentermine therapy despite the potential severe consequences that may result. These patients may receive concomitant therapy with phentermine and other pharmaceutical constituents, which may potentially cause DDIs, more specifically, moderate and severe DDIs. As such, these patients are not only confronted with the consequences of DDIs but are also at risk to experience ADRs as the residual effect of PDDIs.

Role of pharmacist in healthcare system

Pharmacists play a crucial role in the healthcare system by ensuring that patients receive safe and effective medications. They are responsible for dispensing medication, advising patients on drug interactions and side effects, monitoring medication therapies, and collaborating with other healthcare professionals to optimize patient outcomes additionally, pharmacists provide patient education on disease management, medication compliance, and lifestyle modifications. They also serve as drug information experts, conducting drug utilization reviews and providing guidance on appropriate medication selection and dosing. The role of pharmacists is becoming increasingly important as healthcare systems strive to improve patient safety, reduce medication errors, and control healthcare costs. As medication experts, pharmacists are well-positioned to help address these challenges and improve the overall quality of care provided to patients. As a summary we can say that “Physician gives medicine to the patients but life to medicine given by pharmacist”

Pharmacists' Perceptions on Safety Alerts of the Drug Utilization Review (DUR) in Electronic Health Records in a Tertiary Healthcare Hospital.

Electronic Drug Alarms and Drug Utilization Reviews (DURs) are crucial in improving patient safety by reducing the dispensing of contraindicated medications and minimizing adverse drug events. The DUR system often generates low-level alerts, making it challenging for pharmacists and doctors to discern more critical alerts. This can result in alert fatigue, causing burnout and jeopardizing patient safety. A cross-sectional study was conducted in a tertiary hospital to explore pharmacists' perspectives and experience with the DUR system. This study aimed to identify their responses to alerts indicating a need to change the original prescription and the difficulties encountered. Out of all the participants, 85% had prior experience with DUR alerts. However, 40% of them expressed dissatisfaction with the alerts. Moreover, 88% of the participants received highly frequent DUR alerts, but only 40% believed that DUR alerts could identify rare adverse drug reactions. Additionally, only 27% of the participants altered their prescriptions based on alerts for the MAOI/serotonin modulator. The survey showed that 66% of participants believe improvements are necessary for the DUR system. Specifically, 77% of participants felt that more information is needed on overlapping prescriptions, 82% on patients with chronic diseases, and 82% on potential reactions caused by co-administration. At the same time, 75% raised concern about the need for backup for any server breakdown. Positive perceptions about DUR lead to changing the prescription in response to an alert. Therefore, improving the DUR system is crucial to prevent pharmacists from missing important alerts and to increase their awareness of clinically significant alarm signals. By doing so, we can optimize patient safety and contribute to providing high-quality healthcare services.

A Review of Comprehensive and Ethical Utilization of the Worlds Biomass Resources

In conventional practice, unprocessed biomass resources are transported to biorefineries where they undergo preprocessing to become feedstock before undergoing conversion into various products. The constant supply of biomass to biorefinery cannot be achieved on a just-in-time basis due to the fact that various forms of biomaterials, such as energy crops, logging residue, and agricultural residue, are harvested based on their cycle of development and optimum harvesting timeframe. Biomaterials are typically stored and subsequently transported to biorefineries on an as-needed basis. The current approach has resulted in various challenges concerning logistics, biomass degradation caused by fire and microorganisms, and irregular quality of feedstock as a result of the changing characteristics of the delivered biomass materials. This has been observed through previous encounters. The aforementioned factors have resulted in elevated feedstock expenses, reduced processing capacity, and diminished product output for biorefineries. The present study introduces a novel approach to tackle the challenges associated with conventional methods of biomass feedstock procurement, retention, and preliminary processing, as discussed earlier. This strategy comprises three fundamental elements: firstly, the conservation and preparation of biomass throughout its storage; secondly, the incorporation of all biomass components, even those typically deemed as refuse or impurities; and thirdly, the optimization of the worth of each component. The implementation of this novel methodology involves the establishment of feedstock preprocessing depots in close proximity to the sources of biomass production

Abdominal aortic junctional tourniquet (AAJT-S): a systematic review of utility in military practice

IntroductionHaemorrhage is the leading cause of potentially survivable death on the battlefield. Despite overall improvement in battlefield mortality, there has been no improvement in survival following non-compressible torso haemorrhage (NCTH)....

Should Medical Insurance Review Serve the Patient's Best Interests? Examples and Considerations Illustrated by Behavioral Health Cases.

Physician medical directors working for health care insurance companies conduct utilization reviews, participate in quality-of-care reviews, and adjudicate appeals. As a result, they have access to substantial and important clinical information. The medical director may have both current and historical information that can assist the treatment team in providing care. Sharing this information with a patient's current health care provider(s) is problematic due to concerns about patient privacy and the insurer's goal of not assuming legal liability for patient care. While this paper considers legal issues, it predominantly addresses the ethical responsibilities of medical directors who have valuable information unavailable to or unrecognized by the treatment team. Although it is important to consider sharing general medical information, this paper emphasizes the sharing of behavioral health information, which can be highly sensitive but also pertinent to psychiatric and other medical treatment choices. We suggest that clinical information should flow from insurer to provider when the insurer has information that will benefit the patient or prove crucial to optimal care rather than just flow from provider to insurer for the purposes of claims payments. To support and secure that flow, the paper outlines procedures for determining the need to share information, the means of providing that information, ways to separate liability, and processes for protecting privacy.

Efficient Utilization of Carbon Dioxide in Power-to-Gas and Power-to-Liquid Processes: A Vital Path to Carbon Neutrality

A large number of CO2 emissions caused a serious greenhouse effect, aggravating global warming and climate change. Therefore, CO2 utilization has been a research hotspot, especially after the Paris Agreement, and among the various CO2 utilization technologies, the power-to-gas (PTG) and power-to-liquid (PTL) processes have recently attracted significant attention because they can transform CO2 into fuels and/or chemicals. Considering the lack of detailed information in the literature with regard to process design and economic analysis, we have critically and comprehensively summarized the recent research progresses concerning the PTG and PTL processes. Herein, we mainly focus on the power-to-methane in the case of PTG and the power-to-syncrude, power-to-methanol, and power-to-ethers in the case of PTL. From the technical point of view, the bottleneck problem of PTG and PTL processes is the low system efficiency, which can be improved by heat integration and/or process integration. Meanwhile, from the economic point of view, the production cost of PTG and PTL processes needs to be further reduced by the following measures, such as by increasing the carbon tax, lowering the electricity price, improving the electrolysis efficiency, reducing the capital expenditure of the electrolytic cell, and formulating sustainable incentive policies. The main purpose of the paper is to present a comprehensive updated review of CO2 utilization in PTG and PTL processes from process system integration, the techno-economic aspects, such as, state-of-the-art synthesis technologies, process system integration and the production cost, and provide useful information and reliable suggestions for the future development trends of the PTG and PTL processes.

Teaching Independent Decision-Making Through a Computer-Based Drug Utilization Review Simulation.

Background: Drug utilization review (DUR) skills are important for pharmacists across all settings. Computer-based DUR simulations to teach student pharmacists are currently scarce. This article describes a computer-based DUR simulation that required limited faculty and financial resources and was implemented in collaboration among 3 institutions. Objective: To describe the innovation of a computer-based DUR simulation and its impact on pharmacy students' knowledge and confidence of DUR skills. Methods: This pre-post educational study assessed a computer-based DUR simulation that replicated the DUR process in dispensing systems. First- and third-year pharmacy students at 3 institutions were guided through simulated patient cases with various medication-related problems. The self-paced activity provided students with immediate, formative feedback and rationale for each option after an attempt was made in lieu of faculty intervention. Students completed pre-and post-assessments to evaluate changes in knowledge and confidence. Knowledge was assessed by comparing results of multiple choice and matching questions on the pre- and post-assessments. Confidence was assessed by the change in self-reported confidence scale measurements. Results: Students at all institutions (N = 405) had nonsignificant changes in knowledge scores from the pre-assessment to the post-assessment, with the exception of 1 question. All confidence survey questions significantly improved from pre- to post-assessment. Conclusion: The DUR educational innovation had a nonsignificant overall impact on students' knowledge but significantly improved confidence in their abilities. Skills-based instruction provides additional practice to increase student confidence.

The Role of Hospital Transfusion Committee in Ensuring Rational Use of Blood

A Hospital Transfusion Committee (HTC) is a governance body established within the hospital to ensure appropriate blood product use, auditing blood use in the hospital and monitoring and preventing adverse events. The primary goal of HTC is to promote the safe and effective use of blood and components. It is important to educate the end users of blood components to close the gap in medical education pertaining to transfusion medicine. Comprehensive blood utilization review and reporting to management ensures that corrective actions are taken when needed. Meeting is held annually in our setting to discuss practices within the hospital and scope of improvement. HTC provides an active forum for communication between staff directly involved in clinical and laboratory-based patient blood management and blood transfusion activities, to provide solutions, feedback and education in relation to identified problems and to ensure that transfusion practice accords with best practice and aligns with national standards.

A Meticulous Review of Clinical Utility of Madhura Rasa as Expounded in Charaka Samhitha

Ayurveda, the science of life, is one of the oldest medical sciences in the world. One among the Great Trio of Ayurveda is Charaka Samhitha by Agnivesha. It is constituted of 120 chapters spread across 8 Sthaanas (sections). The review of references of Madhura across Charaka Samhitha was started by thorough screening using E–Samhitha where Madhura or its synonyms were searched for. The references obtained were tabulated with brief context, application and usage. The literature search of Charaka Samhitha proffered 104 references pertaining to clinical utility of Madhura Rasa were Madhura /its synonyms were directly mentioned. From the 104 references of Madhura Rasa, 14 contexts pointed it out as Nidana – causative factor, 31 contexts as Lakshana – Signs/symptoms/properties and 59 contexts highlighted it as a Chikitsa – treatment/essential regimen. Of these 104 references, 93 were for internal usage and 11 for external utility. Further work towards use of appropriate drugs from Madhura Skandha is essential for beneficial and effective use of Madhura Rasa in clinical practice.

National review of acute pain service utilization, models of care, and clinical practices within the Veterans Health Administration

IntroductionThe Veterans Health Administration (VHA) is the largest healthcare network in the USA and has been a national leader in opioid safety for acute pain management. However, detailed information on...

Drug Utilisation Review among Geriatric Patients with Noncommunicable Diseases in a Primary Care Setting in Malaysia.

A prospective cross-sectional study was conducted to analyse the drugs prescribed to the elderly population with noncommunicable diseases and to determine the polypharmacy at a primary care clinic in Negeri Sembilan, Malaysia. The study was conducted for 6 months at the primary care clinic of Gemas. Geriatric patients above the age of 65 and diagnosed with noncommunicable diseases were included upon providing written informed consent. The majority of the geriatric patients were between 65 and 69 years (mean: 69.72 ± 2.85) and prescribed 4 or more medications (mean: 5.18 ± 0.64, p = 0.007). More than 95% (n = 295) of the geriatrics were found to have multimorbidity, in which around 45% (n = 139) had type-2 diabetes together with hypertension and dyslipidaemia. Combination therapy was prescribed to more than 97% (n = 302) of the elderly, whereas cardiovascular and endocrine medications were the most commonly prescribed. Ten prescriptions were found to have drug-related problems, prescribing cascade (80%), lack of medicine optimisation (10%), and inappropriate prescription (10%). In this study, the majority of the elderly had multimorbidity; polypharmacy was commonly seen among geriatric patients. Polypharmacy is the biggest threat to the elderly population, as it increases the chances of falls and fall-related injuries. Medicine optimisation and deprescribing will reduce the chances of drug-related problems and morbidity and mortality associated with polypharmacy and over-consumption of medications. Hence, the study recommends the health fraternity look for medication optimisation and deprescribing to reduce the future complications associated with polypharmacy.

HPR125 Descriptive Study Investigating Impact of Transition to Universal Health Insurance Coverage on Utilization of Healthcare in Sudan, 2016 - 2021

Since 2016, Sudan was transitioning from limited healthcare subsidization to universal health coverage (UHC). Increasing healthcare access was widely considered beneficial, but some worried that UHC would overwhelm clinical services. In 2020 and 2021 UHC faced the challenge of Covid-19. We undertook a review of national healthcare utilization and enrolment data in order to better understand the impact of UHC in Sudan.

Ultrasound-Accelerated Catheter-Directed Thrombolysis.

Venous thromboembolism is a very common presentation in the hospital setting. In patients with high-risk pulmonary embolism (PE) or PE and hemodynamic instability, systemic thrombolytic treatment is generally indicated. In those with contraindications to systemic thrombolysis, catheter-directed local thrombolytic therapy and surgical embolectomy are currently considered. In particular, catheter-directed thrombolysis (CDT) is a drug delivery system coupling the endovascular drug administration nearby in the thrombus and the local facilitating effect of ultrasounds. The applications of CDT are currently debated. Here we provide a systematic review of the clinical utilization of CDT.

A progressive review of hybrid nanofluid utilization in solar parabolic trough collector

The most reliable, cleanest, and accessible alternative energy source today is solar energy. Alternative forms of solar energy cause the least environmental damage. The period demands the use of renewable resources due to the depletion of fossil fuels and the rising cost of electricity. Additionally, unlike these renewable sources, fossil fuels emit CO2. Therefore, the usage of alternate sources assists to diminish greenhouse gases and prevent climate warming. Through the process of using solar energy, which is then transformed into electrical energy and then thermal energy with the aid of a steam turbine, the typical heat transfer fluids have a moderate thermal conductivity; in this case, solid nanomaterials are used to boost this conductivity, and nanofluids play a crucial role. The most widely used solar concentrating technique worldwide is the parabolic trough collector (PTC). In order to present various models and media used to assess the consequences of nanofluids on thermal characteristics for PTC delivering an optimal result, this study compares work conducted earlier in the field. The study also demonstrates that the thermal and optical properties can be improved by utilizing hybrid nanofluids as the heat transfer fluid (HTF) inside the absorber tube of the PTC. Numerous experimental experiments have shown that employing hybrid nanofluids improves thermal characteristics more significantly than using monofluids.

Systematic Literature Review of Drone Utility in Railway Condition Monitoring

Systematic Literature Review of Drone Utility in Railway Condition Monitoring

HSD20 The Changes of Prescription Patterns after Providing Therapeutic Duplication Dur(DRUG UTILIZATION REVIEW) Information in Outpatient Veterans at Vhs Medical Center

Therapeutic duplication (TD) information is one of the drug utilization review (DUR) system provided by Health Insurance Review and Assessment Service (HIRA). TD provides information about duplicated agents in same therapeutic group used together in one patient over the same period. It cannot expect any additional medical effect and the risk of adverse effects could be increased. We figure out the changes in TD prescribing pattern through DUR in VHS medical center.

Effect of antifungal stewardship on micafungin prescribing practices in intensive care units at a tertiary-care hospital

Background: Fungal diseases are associated with substantial global mortality and economic burden, especially in critically ill or immunocompromised patients. Antifungal resistance has emerged as a barrier to treating invasive fungal infections, but antifungal stewardship is still a developing effort due to limited data. Here, we describe the antifungal prescribing practices and the impact of antifungal stewardship on micafungin days of therapy (DOTs) in critical care units. Methods: This retrospective study included patients who were admitted to the intensive care unit (ICU) at a tertiary-care hospital in Washington, DC. The preintervention group included baseline micafungin use data between January 1, 2021, and May 31, 2021. The postintervention group included prospective audits, feedback on micafungin orders by a clinical pharmacist, and education on the appropriateness of the antifungal agents. The postintervention group included patients admitted between June 1, 2021, and December 31, 2021. Approval was obtained from the institutional review board. Results: The overall average of micafungin days of therapy (DOT) per 1,000 patient days present in the preintervention group versus the postintervention group was 33 versus 24 days, respectively. Moreover, 121 patients were randomly selected for a more detailed retrospective review to define micafungin prescribing practices further. Of these, 73 patients (60.3%) were male; the median age was 63 years. The most common cause for prescribing micafungin in both groups was empiric antifungal coverage (62.8%), followed by fungemia (12.4%). The most common organism isolated was Candida albicans. For other sources of infection and organisms isolated, refer to Table 1. In-hospital mortality occurred in 63 (52.06%) patients in both groups. Conclusions: Antifungal stewardship through prospective audit and feedback and education by clinical pharmacists decreased micafungin DOTs in critical care units. Empiric prescribing of micafungin is highly prevalent in the ICU despite the low incidence of invasive fungal infections. Although periodic drug utilization reviews and pharmaceutical surveillance can help reduce the prolonged duration of micafungin therapy in the ICU, more robust and routine antifungal stewardship is key to the appropriate use of micafungin to avoid the emergence of antifungal resistance.Disclosures: None

A DRUG UTILIZATION STUDY OF ANTIMICROBIAL DRUGS AT TERTIARY CARE HOSPITAL SOUTHERN RAJASTHAN

Background: Irrational usage and higher utilization of antimicrobial agents has become a major problem in all health care facilities all over the world, further give rise to antimicrobial resistance. Inappropriate use of antibacterial drugs may result in increased adverse drug reaction and also increase cost of treatment. The aim of the study was to evaluate and study drug utilization or drug distribution pattern of antimicrobial drugs. The objective of the study was to determine the average number of antibiotics prescribed per prescription, to evaluate the prescribing pattern and frequency, and to determine the most commonly prescribed antibiotic. Method: The present study was a prospective study done in general medicine ward of tertiary care teaching hospital to evaluate the utilization pattern of antibiotics. A total number of 208 patients were included in the study. Results: The ratio of male population is more as compared to females and most of the patients were in the age group of (61-70) years. The study report shows that most common class of antibiotics prescribed were cephalosporin (45.01%) followed by penicillin (14.74%), quinolones(13.94%), macrolides (7.56%), tetracyclines (4.38%). Study reports shows that (40.23%) of the prescription were prescribed with ceftriaxone (monocef). Conclusion: In this study maximum number of prescription had prescribed only one antibiotic as per W.H.O. A strict protocol for prescriber is now at utmost requirement to promote safe and rational use of antibiotic. KEYWORDS: Antimicrobial resistance, drug utilization evaluation, rational use, prescribing pattern, drug utilization review

EPH198 The Sustained Impact of COVID-19 on Opioid Dispensing in California

Opioid overprescribing played a major role in the onset of the American opioid epidemic. During the COVID-19 pandemic, healthcare access had dramatic changes that potentially impacted high-risk opioid prescribing among healthcare providers and high-risk opioid seeking behaviors among opioid recipients. The study aims to assess the impact of the COVID-19 pandemic on trends in opioid dispensing during the 14 months before COVID-19 and 21 months after in California. Analyzing dispensing data from California’s Controlled Substance Utilization Review and Evaluation System (CURES)-Prescription Drug Monitoring Programs (PDMPs), the study harnessed a segmented regression model to measure changes in temporal trends in high-risk opioid dispensing associated with the onset of the COVID-19 pandemic. Four measures of high-risk opioid utilization were analyzed: (1) multiple provider episodes, (2) overlapping opioid prescription for seven or more days, (3) overlapping opioid and benzodiazepine for seven or more days, and (4) high standardized dosage of opioid prescriptions per month. The study assessed dispensing records from 1,737,984 recipients before the pandemic period from January 18, 2019, to December 17, 2021, and 1,873,962 recipients during the pandemic period from January 18, 2019, to December 17, 2021. The segmented regression analysis showed that the onset of the pandemic significantly changed the decreasing trend on high-risk measurements of (1) multiple provider episodes (P-value=0.0125) and (4) high standardized dosage of opioid prescriptions (P-value=0.0312). Although all four indices presented a decreasing trend from the study initiating time, the model findings show that COVID-19 significantly resisted such long-term declining trends. We observed a gradual decrease in opioid dispensing in recent years. The COVID-19 pandemic had a sustained effect on high-risk opioid dispensing behavior, decelerating the declining trend of high-risk behavior occurrences.